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Risk of and risk factors for hypoglycemia and associated arrhythmias in patients with type 2 diabetes and cardiovascular disease: a cohort study under real-world conditions

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Abstract

Aims

Severe hypoglycemia is one of the strongest predictors of adverse clinical outcomes in patients with type 2 diabetes. Our study addressed the question whether there is a relationship between hypoglycemic events (HE) and severe cardiac arrhythmias in type 2 diabetic patients with established clinical risk factors under real-world conditions.

Methods

We included 94 patients with type 2 diabetes and documented cardiovascular disease, in which interstitial glucose values and Holter ECG were recorded for 5 days in parallel. Patients received a stable treatment with insulin and/or sulfonylurea and were instructed to record symptoms of hypoglycemia or arrhythmias.

Results

Continuous glucose monitoring revealed 54 HE (interstitial glucose <3.1 mmol/l) in a total of 26 patients. Patients perceived only 39 % of HE during the day and 11 % of HE during the night. Patients with HE had a significantly higher number of severe ventricular arrhythmias [ventricular tachycardia (VT) 32.8 ± 60 vs. 0.9 ± 4.2, p = 0.019], and multivariate regression analysis revealed the duration of severe HE and TSH level as independent predictors of the occurrence of a VT.

Conclusions

In conclusion, our study suggests that hypoglycemia might be able to trigger at least under certain circumstances, such as low TSH, ventricular arrhythmias under real-world conditions. The large number of unrecognized HE and VT in vulnerable patients treated with insulin or sulfonylurea should encourage the practitioner to focus on stable glucose control and to search for silent HE.

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Acknowledgments

The authors thank Medtronic for supplying the CGM equipment.

Conflict of interest

The authors declare that there are no potential conflicts of interest relevant to this study.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and Animal Rights disclosure

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Medizinische Klinik III, Universitätsklinik Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany

    Frank Pistrosch, Stefan R. Bornstein & Andreas L. Birkenfeld

  2. Studienzentrum Professor Hanefeld, GWT-TU Dresden GmbH, Fiedlerstr. 34, 01307, Dresden, Germany

    Frank Pistrosch, Xenia Ganz, Andreas L. Birkenfeld, Elena Henkel & Markolf Hanefeld

Authors
  1. Frank Pistrosch
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  2. Xenia Ganz
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  3. Stefan R. Bornstein
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  4. Andreas L. Birkenfeld
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  5. Elena Henkel
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  6. Markolf Hanefeld
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Correspondence to Frank Pistrosch.

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Pistrosch, F., Ganz, X., Bornstein, S.R. et al. Risk of and risk factors for hypoglycemia and associated arrhythmias in patients with type 2 diabetes and cardiovascular disease: a cohort study under real-world conditions. Acta Diabetol 52, 889–895 (2015). https://doi.org/10.1007/s00592-015-0727-y

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  • DOI: https://doi.org/10.1007/s00592-015-0727-y

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